The Corrections Department removes opiate pain killers, ritalin, and even anti-depressants from prisoners. It uses a 'mimimum dental services policy'. This causes intense suffering for thousands of prisoners. So does it amount to torture?

Many New Zealanders seem to believe that those who end up in prison get what they deserve. I can only suspect they're unaware the Corrections Department uses a variety of cruel, inhumane and degrading practices on a daily basis, which induce intense pain and suffering for people in prison. These practices are a form of psychological torture. Although those who break the law may deserve to be in prison, no one deserves this kind of treatment. For those who are on remand – yet to be convicted of a crime – it's undoubtedly unfair.

To the average coward like myself, having my toenails extracted with a pair of pliers sounds a lot worse than being water boarded. But a report in the March 2007 issue of Archives of General Psychiatry, says psychological techniques – such as exposure to adverse environmental conditions, forced stress positions, hooding, blindfolding, isolation, forced nudity, threats, humiliating and degrading treatment – cause just as much trauma and distress as physical techniques.

This is because psychological techniques produce physical effects – and vice versa. For instance, keeping someone awake for days on end causes a whole range of physiological effects including headaches, impaired memory and cognitive functioning, high blood pressure, cardiovascular disease, stress, anxiety, depression, hallucinations and psychosis. In other words, it can drive you crazy. Isolation and sensory deprivation produce similar results.

This means that in terms of suffering, there is very little distinction between physical torture and “other cruel, inhuman and degrading treatment.”

This conclusion is backed up by the New Scientist, which says research on 300 torture survivors from the former Yugoslavia shows that prisoners subjected to psychological torture experienced just as much mental anguish (measured by rates of post-traumatic stress disorder) as those who were physically tortured. New Scientist quotes US Senator John McCain, who was captured and tortured in Vietnam, saying:

"If he were forced to make a decision between enduring psychological or physical torture, he would not hesitate to pick the latter”.

80% of countries use torture

We tend to think that torture is practised mainly in dictatorships, former communist countries, third world countries – and by the United States at Guantanamo. But according to Christian Davenport, Professor of Government and Politics at the University of Maryland, 80% of the countries in the world torture someone in any given year. Although physical torture is less common in democracies, the 80% figure includes the use of psychological techniques that do not leave permanent marks or other physical evidence. Davenport says:

“Research shows that torture is depressingly common, and that democracies have led a global shift to ‘clean’ techniques that make torture harder to detect.”

Darius Rejali, an internationally recognized expert on government torture and interrogation, agrees. In Torture and Democracy, he says that as democracy and human rights spread after World War II, so too did the use of ‘clean’ techniques using electricity, ice, water, noise, drugs, and stress positions. Led by the US, Britain and France, Rejali argues that democracies not only tortured, but “set the international pace for torture”.

“The purposeful inflicting of extreme pain, whether mental or physical, by government officials or by private individuals at the instigation of government officials. This includes the use of physical and other force by police and prison guards that is cruel, inhuman, or degrading, and deaths in custody due to tangible negligence by government officials.”

Torture in New Zealand prisons

In New Zealand, the Crimes of Torture Act was passed in 1989 and made all forms of torture illegal. This has not stopped the Corrections Department from using cruel, inhumane and degrading practices on prisoners. For instance, every year, more than 3,000 prisoners are forced to suffer sleep deprivation and social isolation in the At Risk cells in our prisons.

Exacerbating the cruelty, this form of torture is reserved for prisoners who are already suicidal or psychologically vulnerable. They are also humiliated by having to perform the naked squat three or four times a day.

Thousands of prisoners are also subject to a form of enhanced pharmacological torture. Instead of being given drugs which cause pain, prison doctors in New Zealand are told to take medication off prisoners who are in pain. Section 6.1.1 of the Department’s Medicines Policy “actively discourages” doctors from prescribing opiate (pain killers), benzodiazepines (for anxiety), ritalin (for ADHD) – or any drug which might be ‘traded’ in prison. In some prisons, this policy appears to include anti-depressants and anti-psychotic medication. In other words, prison doctors are encouraged to breach their medical ethics, ignore the welfare of their patients, and allow them to suffer.

Richard Barriball was a victim of this ‘discouraged medication policy’. Prior to being admitted to Otago prison in 2010, he was on four different pain medications after a series of operations on his arm. On his first day in prison, the prison doctors took away two opiate pain killers; four days later they took away the benzodiazepines he had been on for years.

With increasing pain, anxiety and in severe withdrawal, he committed suicide three days later. The coroner said Corrections provided him with sub-optimal care.

Then there’s prison dental torture. The Department has a ‘minimum dental services policy’whereby prisoners with toothache or an abscess can have the tooth extracted – but are generally not allowed to have fillings. Long term prisoners, with a sentence of more than one year, may receive fillings provided their teeth were in good condition prior to coming to prison. But there are lengthy waiting lists. Prisoners serving less than one year (80% of all those in prison), are told to wait till they get out to see a dentist.

All of these reports describe cruel, inhuman and degrading treatment of prisoners in New Zealand. Most of the pain and suffering is the result of ‘tangible negligence by government officials’, although the Department’s ‘discouraged medication policy’ and ‘minimum dental services policy’ formalise this neglect and make it official policy.

The three most recent reports all provide case histories and quite graphic details of the suffering these practices impose. But there’s one thing missing from all three reports. The authors haven’t had the courage to name this ‘treatment’ for what it really is – institutionalised, psychological and pharmacological torture.

Of course you can always avoid prison by not breaking the law to begin with.

I didn't think there would be many, but I did assume that there were some people who truly believed that not only has no-one innocent ever been convicted, however I am very surprised to come accross someone so convinced of the infallibility of the police and courts that they have the view that no-one innocent has ever been charged and detained in a remand prison. Wow.

I didn't think there would be many, but I did assume that there were some people who truly believed that not only has no-one innocent ever been convicted, however I am very surprised to come accross someone so convinced of the infallibility of the police and courts that they have the view that no-one innocent has ever been charged and detained in a remand prison. Wow.

Well, I didn't think there would be many who would immediately take my arugment to an extreme. It was just a general observation. Wow.

There seems to be some faulty logic here. Must we now treat all prisoners as if they're innocent just in case one actually might be?

Sure the system is imperfect, but the departure point for the prison managment is that they are receiving people who have been found guilty in a court of law, with ample legal aid, of a (usually violent) crime.

As long as prisoners put things *up there* guards will require them to do the squat upon entering prison.

There seems to be some faulty logic here. Must we now treat all prisoners as if they're innocent just in case one actually might be?

Does the guilt or innocence of a person make any difference as to whether we should let the teeth rot out of their heads whilst detaining them behind high walls and barbed wire? I mean, it's not like they've got a lot of other options when it comes to getting their teeth treated!

Andrew, it's an interesting balance. The old saying is 'better ten guilty men go free than one innocent man go to prison' or similar. But it seems that attitude no longer prevails.

The question Roger's posing is that just because they're guilty of a crime, does that mean they deserve the sort of treatment he describes? Do two wrongs make a right?

To your last point - you're touching on some interesting questions. If we know that prisoners do certain things (smuggling contraband *up there*) and those things may end up hurting people, how far do we go to stop that happening? Because some do it, should all suffer?

Andrews point: We are definitely not "letting their teeth rot". As the article says, they get their rotten teeth extracted. Attention to oral hygiene likely wasn't a big feature of their lives prior to incarceration anyway.

Tim's point is indeed more interesting. This society choses to warehouse its psychopaths in prisons. Nothing is acheived other than keeping them out of circulation and thus limiting the damage they do. If I recall over 80% are caught reoffending within 5 years and the police clearance rate for violent crime is about the same. In other words we have a relatively small percentage of the population going around in circles between crime and punishment at great cost to the tax payer and society in general.

Have you got any better idea? It's easy to point out a problem but not so easy to find solutions. I do have a few thoughts on the matter though...

Except, Andrew, there are more people in prisons than just psychopaths. We have such a high incarceration rate. And although there's been little publicity, it's fair to say that we're doing more than just keeping them out of circulation – at least, we're doing more than we used to. Rehab rates are up and I'll be curious to see if that changes reoffending.

But again Roger's point here is not whether we lock up or not or how we limit reoffending etc. It's how we treat people when they're inside. Are you happy with the treatment described? I mean, taking anti-depressants off someone seems pointless and damaging.

Corrections 'minimal dental service policy' basically says if prisoners had poor dental care before they came to prison, Corrections will continue to give them poor dental care. Corrections also seem to believe that if prisoners have poor mental health before they came to prison, they will continue to receive poor mental health treatment in prison.

What about physical ailments? If a prisoner has diabetes, should Corrections take their insulin away. If they have high blood pressure, should Corrections deny them proper treatment for that... I don't think so. Nor should Corrections deny prisoners proper dental care or proper mental health care. Because they are in the custody of the Department, it actually has a legal duty of care.

As regards anti-depressants, I'd take them off most of the unimprisoned population! But that's another story. I'm not a warder and neither are you so it's hard for us to judge. My suspicion is that the pills would become a saleable commodity in prison and would be abused somehow. But our main focus should be the victims of these crimes. IMO the prisoner has lost some aspects of his 'human rights' by commiting the crime. Freedom for one. In NZ we only imprison for REALLY serious offences judging by the number of violent crims who get home detention, so I have little sympathy.

PS:Yes we should change the dental policy...so then I can steal a car, get incarcerated and then apply for those gold caps I've always fancied... ;-)

Perhaps we should be taking an interest in the Norwegian approach practiced by Arne Kvernvik Nilsen, the departing governor of Bastoy prison. Apparently it's managed to reduce re-offending rates to just 16%, but has been criticised for being a holiday experience for inmates.

“The purposeful inflicting of extreme pain, whether mental or physical, by government officials or by private individuals at the instigation of government officials. This includes the use of physical and other force by police and prison guards that is cruel, inhuman, or degrading, and deaths in custody due to tangible negligence by government officials.”

But how about the witholding of pain relief? Thats doesn't fit the definition of "purposeful inflicting of extreme" so its not torture, right?

Of course we think it is reasonable that we should not let dental pain go untreated. But what if the sufferrer was not one to go to dentists or get fillings when they were on the outside. Is it then torture if he receives the same treatment inside? The definition covers death in the event of lack of remedial action but you can go a long way before death occurs. So. according to the definition, if he hasn't died then your negelct of pain relief, for example, hasn't crossed the threshold into torture.

And what is extreme? Obviously inflicting a little bit of pain in an effort to encourage co-operation is all right because that is not extreme. Pehaps even a little bit more. But when does it become extreme? How do we measure extreme?

It all gets messy. We would all consider pulling toenails or holding hot coals to genitals torture. Most of us would think that some kind of denial of privileges was warranted to encourage compliance with reasonable rules. But in bewteen there is a grey area that will be a whole lot bigger than most of us would be comfortablew with once we start working through it.

I suspect the line in that grey area will be drawn in different places by different cultures. But who has got it right?

Andrew: In 2011, there were 12 suicides in prison. This made the suicide rate that year 11 times higher than the rate in the commiunity - bearing in mind - its very hard to commit suicide in prison. Corrections stopped another 23 prisoners in the process of trying to kill themselves.. If they don't stop attempted suicides, the rate in prison would be 30 times higher. The obvious conclusion is that inmates are driven to suicide by the appalling treatment they receive in prison.

Rab wrote: "But how about the witholding of pain relief? Thats doesn't fit the definition of "purposeful inflicting of extreme" so its not torture, right?"

Witholding pain relief is required by the Departments Medicine Policy. It is therefore deliberate and entirely "purposeful". This is state sanctioned torture. Is it extreme? It contributes to the high suicide rate in prison so I guess so.

As an aside, I have a friend from the UK who was the CMO for a British Prison for 5 years. He said that he had several aged clients during that period who had come in for a stretch and had been addicted to various ophiates for decades. Rather than try to get them off it, he supervised a daily dose to ensure they didn't die whilst in prison. His opinion was that most of these ophiates did little harm to the individual just as long as they had enough financial resources to maintain their diet at a good level. Hence the longevity of folks like the Rolling Stones.

No matter what their crime, prisoners should be treated humanely. This includes access to adequate healthcare; since dental health is an integral part of general health, it follows that prisoners should have access to adquate dental care. The paradox with dental care, of course, is that in the community it is beyond the financial reach of the poor - which group will encompass many of those who fetch up in prison. So they may well have better access to this aspect of healthcare while in prison, but I can't see that as being a reason to deny them treatment.

On the other hand, many law-abiding taxpayers are obliged to languish for years on the waitlist for knee surgery, because ACC has declined cover for a workplace injury. This has happened to a member of our household. I think we can be forgiven for being a little aggrieved when we hear that a violent murderer gets a prosthetic leg not long after he's imprisoned. We're of the view that this goes somewhat beyond the definition of "humane treatment".

"PS:Yes we should change the dental policy...so then I can steal a car, get incarcerated and then apply for those gold caps I've always fancied... ;-)"

Peggy: Given the understanding tone of your comments, I presume that you're not aggrieved that a prisoner with no leg is given a prothesis - just aggrieved that your family member had to wait for knee surgery. Fair enough. But then you appear to say that getting a prothesis "goes beyond the definition of humane treatment", I suspect fitting someone a prothesis is a lot easier and cheaper than obtaining knee surgery.

Not giving a prothesis to someone with only one leg would surely be inhumane....especially someone in prison? Besides I don't think the prison officers would want to carry a one legged prisoner around - especially a psychopath like Graeme Burton who had his leg shot off by the police.

Roger: I grant the points you make. But from our point of view, it does seem as if the priorities are skewed, when our relative - who's lived an entirely blameless life and pays a lot of tax - can't get surgery which would enable a speedy return to painless mobility, and must continue to work while in considerable pain.

I'm not sure that I agree about it being inhumane to deny a prosthesis in the case to which you refer - and of course to which I was also referring. As I understand the situation, he used a wheelchair before he got the prosthesis. And once he had it, it was reported that he made prompt use of his increased mobility to attack another prisoner.

Plenty of people who can't have prostheses for one reason or another manage long-term with wheelchairs. It seems to me that said prisoner would be less of a danger to others if he were obliged to stick with a wheelchair.

And the priorities issue is of moment here as well: there'd be a lot of inoffensive people in the community who have been obliged to wait a much longer time to get a prosthesis.

I think no one would disagree that prsioners should be treated reasonably.

However, I think you are stretching the definition well to one end of that grey area I spoke of when you say that witholding pain relief is torture because it is "purposeful". But that word is only part of the whole phrase. The definition is “The purposeful inflicting of extreme pain, whether mental or physical, by government officials or by private individuals at the instigation of government officials."

Almost everything that occurrs in a prison is purposeful but to be toture it has to be pain that is purposely inflicted and extreme. I would have thought that to "inflict" something must be done rather than not done. Suicide, I would have thought, is often the final result of a whole lot of pressures. A final relatively minor event, such as a badly chosen comment, may tip the balance. Your comment would suggest that you think that if a badly chosen comment did tip the balance it would be extreme because the suicide occurred and therefore qualify as touture.

"I would have thought that to "inflict" something must be done rather than not done."

Sensory deprivation is a form of torture that can drive the victim crazy. It is somethng that is "not done" to the prisoner rather than something that is done. However, the victim is purposefully put into that situation. The same with removing pain medication. On one level nothing is being "done" to the victim - but removing the medication is done with a purpose.

Peggy, I understand your point. But what happens in prison and what happened to your family member are really separate issues. I presume being unable to have a knee operation in the community is largely due to a lack of resources put into health care in NZ. The appalling medical treatment of prisoners is not about resources. It's the result of deliberate policy decisions made by Corrections to deny prisoners clinically appropriate care - based primarily on erroneous assumptions about prison security.

Roger: I do agree with you. The access to protheses by the aforementioned violent murderer - and assorted other psychopaths - aside, I feel great compassion for many prisoners. I'm not excusing their crimes, but I don't see crime as a reason to withhold healthcare which may be needed.

@ Rab McDowell: the withholding of pain relief for, for instance, toothache or arthritis might well be characterised as "torture". As anyone who's experienced either can attest, the pain can be unbearable.

Rodger, thanks for a passionate and thoughtful article. I have visited two prisons in New Zealand, maximum and medium security, the former having more doors, gates and suicides than the latter. The 'corrections' seem to house a great proportion of our mentally ill, intellectually disabled and our poor, it would seem obvious that a humane society would lavish more care and expenditure on these people than is current practice. It appears that this system is trapped in a political and cultural bind of punishment and containment rather than triage, healing and education.

Peggy, I have never considered the excessive duration on a hospital waiting list to be a form of torture but it obviously is (Rodger; I don't think intentionallity of policy matters, the pain is just the same) It might be worth writing to the UNHRC to see what their position on the matter is.

William: that is indeed so: protracted periods waiting for joint replacement, when one is obliged to carry on working - and therefore walking - on the munted joint, is indisputably torture. It's exacerbated by the fact that people often can't take much serious pain relief during the working day, because said pain relief can cloud brain processes which need to be sharp for work. And folk must work: if ACC has declined a claim, there's no chance of earnings-related compensation.

I haven't written to the UNHRC but I have written to the Health & Disability Commission about Corrections 'discouraged medication policy'. The weird thing is that instead of seeing it as a breach of human rights, the HDC actually endorses this policy. In 2008, HDC Education officer, Dr Elizabeth Finn, was asked by Corrections to investigate bullying by prison nurses. She wrote this report describing what she called 'horizontal bullying and related managment problems in prison health services.

In the process, she also validates Corrections' belief that depriving prisoners of opiate pain killers and other medications is a legitimate practice. In other words, the HDC - an agency with responsibility to advocate on behalf of prisoners health issues - supports a form of pharmacological torture on NZ prisoners. I have brought this to the attention of the Ombudsman.